+ PHYSICAL PHYSICAL ACTIVITY FOR THE ELDERLY

THEORY

ContentsContents

1. Benefits of physical activity

Th bl2. The problem

3. How to increase physical activity?3 o to c ease p ys ca act ty

2

+ THE BENEFITS OF PHYSICAL ACTIVITY

Physical Activity (PA)

“Any bodily movement associated with muscular contraction that increases muscular contraction that increases

energy expenditure above resting levels”

Leisure time PALeisure-time PA

Occupational PA

PA at or near the home

PA t d ith t tPA connected with transport

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BENEFITS OF PHYSICAL ACTIVITYBENEFITS OF PHYSICAL ACTIVITY

Management of the diseaseManagement of the disease

Secondary PreventionSecondary Prevention

Primary PreventionPrimary Prevention

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Advantages of Physical ActivityAdvantages of Physical Activity

Prevents Prevents and heals

Diabetes Helmrich SP et al, NEJM 1991Colon cancer Thune I et al, NEJM 1997Breast cancer Thune I et al NEJM 1997

HypertensionCoronary diseaseStroke

Breast cancer Thune I et al, NEJM 1997Osteoporosis Price RL et al, NEJM 1991Falls and fractures Brukner PD et al, MJA 2005Cognitive decay Brukner PD et al, MJA 2005

Obesity

Brukner PD et al, MJA 2005

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Loss of functional capacity with ageingLoss of functional capacity with ageingMuscle resistance Muscle resistance 11--2% 2% per annoper anno

Muscle forceMuscle force 33--4%4%Muscle forceMuscle force 33--4%4%

Aerobic capacityAerobic capacity 33--4% 4% per annoper anno

Bone density maleBone density male 1%1%

Bone density femaleBone density female 22--3% 3%

Flexibility and balanceFlexibility and balance

Proprioception and coordinationProprioception and coordinationProprioception and coordinationProprioception and coordination

Kinesthetic PerceptionKinesthetic Perception

7Temperature Regulation Temperature Regulation

Imp o ement of q alit of lifeImprovement of quality of lifePhysically Activey y

Physically Inactive

Physical i

‘Minimum necessary to

exercise capacity

perform activities of daily living

8 Age Adapted from Young (1986)

+The Problem

Physical activityO f th t i t t hOne of the most important human

functions

Civilization reduces the need for

H man forceHuman forceMovement

AgricultureBuildingsgTransport

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Physical activityOne of the most important humanOne of the most important human

functions

Today

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In great measure eliminated We ignore its importance for health and well-being

The Problem40 – 60 % of the EU adult population leads a sedentary lifestyle

23 5 % is completely sedentary23.5 % is completely sedentary

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No Physical ActivityNo Physical Activity

Poor muscle tonePoor muscle tone

Risk of fracturesRisk of fractures

ObesityObesity

DiabetesDiabetes

Premature AgeingPremature Ageing

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cooking2.0 METs

sleeping 0.9 METs

Energy Cost1 MET = 3.5 mL • kg-1 • min-1 V02

Slow walking on a flat surface3.0 METs

Running quickly on a flat surface12.0 METs

Relationship PA and mortality

MET =

Energy cost

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McAuley P et al. Am Hearth J McAuley P et al. Am Hearth J 20062006McAuley P et al. Am Hearth J McAuley P et al. Am Hearth J 20062006

+INCREASING PHYSICAL ACTIVITY

Guidelines (1)

World Health Organisation

The objective

Goal is to achieve a minimum of 30 minutes of Goal is to achieve a minimum of 30 minutes of moderate-intensity physical activity 5 days a week or at least 20 minutes of vigorous-

h l d kintensity physical activity 3 days a week

Recommended in short bursts of 10-15 minutes

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Guidelines (2)Guidelines (2)

30 minutes a day prevention of chronic diseases

60 minutes a day weight management

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How to increase physical ti it ?activity?

Co nselling methodsCounselling methods:

- Individually or in groups

- In person, by telephone or via internet

- Brief or intensive- Brief or intensive

- Physical activity only or multiple behaviour changes (including smoking and diet)changes (including smoking and diet)

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Behaviour Change

Explain risks

Motivate: why change?

Goal setting: How to change?

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g

Problem Solving Treatment

Goal setting:

Specific: increase physical activity

Measurable: 3 times a week for 30 minutes, 2 weekdays and one weekend dayone weekend day

Achieveable: walking alone

Relevant: walkingRelevant: walking

Timetable: in the next week

“W lk f 30 i h i k”“Walk for 30 minutes three times a week”

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Optimal is not achieveableOptimumOptimum

3-4 times a week, 30-60 minutes a day

High intensity

Not achieveable so:

“Something” is better than “nothing”

Moderate intensity for a long period is better y g pthan high intensity for short

Find something you can achieve eg. Walking, cyclingcycling

Incorporate PA into your daily life, eg. Walk to the shop instead of going by car

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p g g y

Ask your doctor to help you

How to increase physical activity?Type of PA: choose an activity you enjoy

greater effect

PA in daily life: use the stairs instead of the lift

All types of PA are effective: cycling, walking, tennis, golf etc

Try to keep a balance: 2-3 times a week, every week

Try to find family or friends to join you

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Overall improvement in healthOverall improvement in health

Increase physcal activity

Decrease dietary intakeDecrease dietary intake

Involve family and friends in your b h i h th h t h behaviour change they have to change too

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HOW TO CHANGE PHYSICAL ACTIVITY?ACTIVITY?

1. Initial evaluation of possible risks and contro-indications

(PAR-Q Questionnaire Aptitude for Physical Actvity)Physical Actvity)

2. Define an improvement plan with measurable objectives (PASA)measurable objectives (PASA)

FACTORS TO TAKE INTO CONSIDERATION

TYPES OF EXERCISE

CONSIDERATION

Cardiovascular resistanceStrengthBalanceFlexibility

FREQUENCY AND TIME: see recommendationsWHO (World Health Organisation)ACSM (American College of Sports Medicine)

INTENSITY: Borg ScaleINTENSITY: Borg Scale

MODERATE PHYSICAL EXERCISE

Swimming

Cycling

Ping Pong

RowingCycling

Race cycling

Rowing

Dancing

Gardening

Housework

Golf

MORE INTENSE ACTIVITY

Going upstairs, going for an uphill walk or in the

Going for a trip to themountainsuphill walk or in the

hills/mountains

Swimming lengths of a pool

mountains

Skiing

Going trekking in the mountains

Tennis

Horseriding

Examples of resistance activitiesExamples of resistance

activities with moderate effort for the average elderly

Resistance activities withmore intense effort.

person

Moderate:• Swimming

Vigorous:• Climb the stairs or a

slope• Going for a bike ride• Exercise bike• Gardening (digging,raking)• Quick walking on a flat

f

• Shovel snow• Cycle up a hill• Tennis (singles)• Cross country skiing

surface• Sweep or wash the floor• Tennis (in doubles)• Volleyball

R

• Slope skiing• Running

• Row• Dance

STRENGTH AND BALANCEExamplesExamples

STRENGTH AND BALANCEExamples

FLEXIBILITY

FLEXIBILITY

FREQUENCY AND DURATIONOBJECTIVE

30 MINUTES of moderate physical activity

5 days per week

20 MINUTES of intense physical activity

3 days per week

PROGRESSION

gradually increase the frequency and duration

BORG SCALEINTENSITY

Least effort67 Very very easy7 Very very easy89 Very easy 10 Resistance11 Easy1213 More or less difficult

Resistance activity

1415 Difficult 1617 V diffi lt

Strength activity

17 Very difficult1819 Very very difficult2020Most effort

B S l

INTENSITY

E t l diffi lt19

Most effort20

Borg ScaleGENERAL INSTRUCTIONS FOR USE OF THE

SCALE (Rating of perceived exertion)

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Very difficult17

18

Extremely difficult19• While perfoming these exercises, we would like

you to measure your percieved effort – howdifficult the exrcise seems to you overall, not forany particular part of your body.

A little difficult13

14

Difficult15

16• While doing a physicla activity, look at the scale which gos from 6 “no effort” to 20 “maximumeffort”.

• Choose the number which best describes the intensity level of your effort. This will give you a

d id f th i t it f ff t th t

10

Light11

12good idea of the intensity of effort that you are carrying out, and you can use this scale to raiseor lower the intensity of exercise so as to gain the required intensity.

• Try to evalutae your level of effort as honestly aspossible without thinking about the physical

Very little effort7

8

Little effort9possible without thinking about the physicaleffort – it is your feeling of effort that counts, nothow you compare to others.

• Look at the scale and the numbers whichcorrespond to the levels of inensity, then choosea number.

No effort6a number.

BorgBorg scale

Go to your doctor if... Go to your doctor if...

You have chest painYou feel dizzy

p

Excessive breathlessness

Irregular heartbeat

Worrying symptomsy g y p

INTENSITYAccording to the levels of physical activity, we can divide people into three groups. A different intensity level is recommended for each group.

Sedentary (at the moment does not do physical activity)Sedentary (at the moment does not do physical activity)from 7 to 9 on the Borg Scale

Partially Active (some physical activity but not that recommended by thePartially Active (some physical activity but not that recommended by the WHO/ASCM)

from 10 to 13 on the Borg Scale

Active (follow WHO/ASCM recommendations)from 13 on the Borg Scale

It is important to gradually increase the intensity!

BorgBorg Scale

d dadvanced

partially active

intermediate

sedentaryb ibeginner

(Example of Sedentary Profile)BEGINNER

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

R i t R i t R i tResistance20 min.

WalkFrom 7 to 9

Borg

Resistance20 min.

WalkFrom 7 to 9 Borg

Resistance20 min.

WalkFrom 7 to 9

Borg

(Example of Partially Active Profile)INTERMEDIATE

Sunday Monday Tuesday Wednesday Thusday Friday Saturday

Resistance Resistance Resistance30 min. Cycle

10 to13 Borg

30 min. Swim

10 to13 Borg

30 min. Cycle

10 to13 Borg

Strength/Balance15 min.

Strength/Balance15 min.

Stretching for the legs

Stretching for the arms

Stretching for the legs

Stretching for the arms

Stretching for the legs

(Example of Active Profile)ADVANCED

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

R i t R i t R i t R i t R i tResistance30 min

Resistance30 min

Resistance30 min

Resistance30 min

Resistance30 min

St th/ St th/Stength/ Balance

From 15 – 20 min

Stength/ Balance

From 15 – 20 min

Stretching 10 min

Stretching 10 min

Stretching 10 min

Stretching 10 min

Stretching 10 min

PRACTICAL PRACTICAL PART

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Practical Part (1)Practical Part (1)Activity in multidisciplinary groups:

Groups of approx 10 peopleGroups of approx. 10 peopleThree sessions of 10 minutes One group leader for each group (a doctor, nurse, pharmacist or other expert)other expert)

In groups, the participants discuss a case from real life. An example is provided for every group (beginner, intermediate, p p y g p ( g , ,

advanced). They are asked to decide whether the subject of the case study is a beginner, intermediate or advanced level. Distinguishing any risk factors they must then prepare an Distinguishing any risk factors they must then prepare an weekly programme adapted to their needs, with objectives, stages exercised to do and so on.See Handbook for additional details and solutions for Cases A, B See Handbook for additional details and solutions for Cases A, B and C.

21/03/09

Case-studyCase study

C St d A A f 65 Sh i i d h lth d Case Study A: A woman of 65. She is in good health and takes no medicine. She played volleyball regularly until the age of 25 and then gradually reduced her exercise. For the last 20 years she has hardly exercised Her motivation to last 20 years she has hardly exercised. Her motivation to start exercising again is that she has noticed a gradual weight gain over the last five years.

Case Study B: A man aged 72. Slightly high blood pressure which is treated with medicines. He has always played sport and trained for it and has exercised irregularly for the last 20 years. He has decided to take up a regular programme of exercise to better control his blood pressure.

Case StudyCase Study

Case Study C: A man aged 66. He is in good health and takes only oral hypoglycemic agent for a light . He has always played competitive sport in the past and still trains y p y p p pregularly, going to the swimming pool (twice a week) and to the gym (twice a week). He is motivated to follow a personalised exercise programme to improve the results b dobtained.

S f lSuccessful Ageing

A physically and mentally active lifeA physically and mentally active life

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